NPIMap

Individual provider Active NPI

Nusrat Qayyum, PA-C

  • Physician Assistant
  • Midland, MI
National Provider Identifier
1598091134
Registry record updated Jul 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005643 Issued in MI
Practice address
4005 Orchard Dr
Midland, MI 48670-0001
Phone
(989) 839-3325
NPI assigned
Nov 1, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601005643 MI Primary

Addresses

Primary practice location

4005 Orchard Dr
Midland, MI 48670-0001

Mailing address

4967 Crooks Rd
Ste 130
Troy, MI 48098-5801
Phone (248) 952-1601

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141003000796 MI Practitioner - Physician Assistant 9638399173 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WRJ and Associates PLLCGroup PAC ID 1153644653, 7 clinicians

Practice addresses (Care Compare)

44237 Michigan Ave
Canton, MI 48188-2866
Phone (734) 333-9001

80 S Zeeb Rd
Mi Express Care
Ann Arbor, MI 48103-6058
Phone (734) 272-0063

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601005643MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
W.a. Foote Memorial Hospital, Inc Physician Assistant CurrentSince Aug 5, 2017 Accepting new patients
W.a. Foote Memorial Hospital, Inc Physician Assistant CurrentSince Aug 5, 2017 Accepting new patients
Henry Ford Pathology Current Accepting new patients
Waterford Urgent Care PC Past Accepting new patients
Umayr Azimi MD PLLC Past Accepting new patients

Locations

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

813 W Michigan Ave
Jackson, MI 49202
Phone (517) 205-1000

7845 Spring Arbor Rd
Spring Arbor, MI 49283
Phone (517) 205-2580

Interoperability endpoints

  • Direct secure messaging: nqayyum461820@direct.hfhs.org
  • Direct secure messaging: nusrat.qayyum.1@21010.direct.athenahealth.com
  • Direct secure messaging: nqayyum76898@direct.hurleymc.com
  • Direct secure messaging: nusrat.qayyum@2217.securemail.prognocis.com

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595808000000",
    "number": "1598091134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4967 CROOKS RD",
            "address_2": "STE 130",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480985801",
            "telephone_number": "248-952-1601",
            "fax_number": "248-952-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 ORCHARD DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486700001",
            "telephone_number": "989-839-3325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QAYYUM",
        "first_name": "NUSRAT",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-01",
        "last_updated": "2020-07-27",
        "certification_date": "2020-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.